Name-F O A Age -50 Male Admission date
A known RVD on HAART On the continuation phase of antikochs Presented with hx of 1. neck pains 6/12 2. Shoulder pains4/12 3. Bilateral lower limb weakness 4. Upper limb weakness
Neck pain - dull continuous ache worse at night Fever,night sweats weakness –progressive in nature from the foot cranially 1/12 ago Unable to move the lower limbs completely Stool and urine incontinent
Medical assistance at a private facility Cervical spine x ray-C6-c7 collapse Cxr-pleural effusion Started on atikochs12/10/2011 Nerve conduction studies- central weakness With no evidence of GBS MRI-C6,C7 destruction CT scan brain - normal Referred to KNH
Admitted before?when Muscle tear-rt leg No BT No known allergies
Married 2 children A meter connector with NWC Smoked Occasssionally –alcohol No hx of chronic illnesses
Rest of the systems -Non revealing
Sick looking on a stretcher and on a hard cervical collar No pallor Nojaundice No ln
Cervical examination 1.Inspection on a collar No obvious scars,blisters discoloration or skin lessions 2.Bony and soft tissue palpation -There was no regional lymph node enlargement -Thyroid was essentially normal -motion palpation-not performed was on a collar then
activeRotatory cervical compression test Shoulder depression Cervical hyperextension compression test All elicited tenderness Cervical percussion,auscultation Not done -collar
lulrullllrll motor3500 Sensory- pain+ +00 Fine touch++oo propriorecep tion ++o0 Deep reflexes ++o0
Sensory level-L4 Anal wink-not clear Anal tone- reduced bulbocavenous reflex-non reactive
GCS15/15 PBERL Cranial nerves-ok
Vesicular breath sounds No rhonchi No crepitation
Essentially normal
DRE – Anal tone- reduced prostate not enlarged Median sulcus felt Smooth Not adherent to the rectum
C6,c7 collapse with cord compression In a pt who is on mx for potts disease and rvd Ddx-metastatic lession to the cervical spine - granulomatous spine lession - com -primary malignancy-?chordoma
Hgm+esr U/e/cs Lfts Biopsy- C6,C7 corpectomy -strut bone graft -anterior cervical plating